@article{10.11648/j.cajph.20251106.11,
  author = {Bangaman Christian Akani and Ama Kounangui Marie Noelle Ano and Loukou Gilbert Konan and Roméo Kouassi and Awa Madaho Sokodogo and Ekissi Orsot Tetchi and Eugène Konan and Petronille Acray-Zengbé},
  title = {Economic Evaluation of Mobile Payments for Health Workers in Vaccination Programs: A Case Study from Cote d’Ivoire
},
  journal = {Central African Journal of Public Health},
  volume = {11},
  number = {6},
  pages = {335-342},
  doi = {10.11648/j.cajph.20251106.11},
  url = {https://doi.org/10.11648/j.cajph.20251106.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20251106.11},
  abstract = {Background: Timely and reliable remuneration of frontline health workers is critical for vaccination campaign performance, yet in many low- and middle-income countries cash-based disbursement remains vulnerable to delays, leakage, and inefficiencies. These weaknesses undermine accountability and create recurrent financial burdens, particularly in large-scale operations such as polio immunization campaigns. Objective: This study aimed to evaluate the cost implications of shifting from traditional cash payments to digital disbursement through mobile money during Cote d’Ivoire’s October 2023 national polio immunization campaign. Method: A partial economic evaluation was conducted using a top-down costing approach from the payer’s perspective. Data from all 113 districts and 33 regions were analyzed to compare cash-based and mobile money systems. The analysis focused on direct financial costs, including transaction fees (digital) and transport allowances or ghost worker disbursements (cash). A cost-minimization framework was applied under the assumption of equivalent immunization outputs, and deterministic sensitivity analysis was performed to test robustness. Result: Both systems disbursed the same total amount to vaccinators (397,582,460 FCFA). However, cash payments incurred additional costs of 7,820,967 FCFA in transport and 3,938,930 FCFA in ghost payments, while digital payments generated a 1% transaction fee (3,975,825 FCFA). The digital modality produced a net saving of 7,784,073 FCFA (12,435 USD), or 257 FCFA (0.41 USD) per vaccinator. Sensitivity analysis confirmed the stability of these savings across plausible parameter variations. Conclusion: Digital disbursement via mobile money offers a cost-saving and governance-enhancing alternative to cash payments in vaccination campaigns. Although the absolute savings represent less than 2% of total outlays, the benefits in efficiency, fraud reduction, and transparency are significant for health systems facing budget constraints. Cote d’Ivoire’s experience provides evidence for policymakers to consider institutionalizing digital payments to strengthen financial sustainability and support universal health coverage.
},
 year = {2025}
}

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TY  - JOUR
T1  - Economic Evaluation of Mobile Payments for Health Workers in Vaccination Programs: A Case Study from Cote d’Ivoire

AU  - Bangaman Christian Akani
AU  - Ama Kounangui Marie Noelle Ano
AU  - Loukou Gilbert Konan
AU  - Roméo Kouassi
AU  - Awa Madaho Sokodogo
AU  - Ekissi Orsot Tetchi
AU  - Eugène Konan
AU  - Petronille Acray-Zengbé
Y1  - 2025/10/30
PY  - 2025
N1  - https://doi.org/10.11648/j.cajph.20251106.11
DO  - 10.11648/j.cajph.20251106.11
T2  - Central African Journal of Public Health
JF  - Central African Journal of Public Health
JO  - Central African Journal of Public Health
SP  - 335
EP  - 342
PB  - Science Publishing Group
SN  - 2575-5781
UR  - https://doi.org/10.11648/j.cajph.20251106.11
AB  - Background: Timely and reliable remuneration of frontline health workers is critical for vaccination campaign performance, yet in many low- and middle-income countries cash-based disbursement remains vulnerable to delays, leakage, and inefficiencies. These weaknesses undermine accountability and create recurrent financial burdens, particularly in large-scale operations such as polio immunization campaigns. Objective: This study aimed to evaluate the cost implications of shifting from traditional cash payments to digital disbursement through mobile money during Cote d’Ivoire’s October 2023 national polio immunization campaign. Method: A partial economic evaluation was conducted using a top-down costing approach from the payer’s perspective. Data from all 113 districts and 33 regions were analyzed to compare cash-based and mobile money systems. The analysis focused on direct financial costs, including transaction fees (digital) and transport allowances or ghost worker disbursements (cash). A cost-minimization framework was applied under the assumption of equivalent immunization outputs, and deterministic sensitivity analysis was performed to test robustness. Result: Both systems disbursed the same total amount to vaccinators (397,582,460 FCFA). However, cash payments incurred additional costs of 7,820,967 FCFA in transport and 3,938,930 FCFA in ghost payments, while digital payments generated a 1% transaction fee (3,975,825 FCFA). The digital modality produced a net saving of 7,784,073 FCFA (12,435 USD), or 257 FCFA (0.41 USD) per vaccinator. Sensitivity analysis confirmed the stability of these savings across plausible parameter variations. Conclusion: Digital disbursement via mobile money offers a cost-saving and governance-enhancing alternative to cash payments in vaccination campaigns. Although the absolute savings represent less than 2% of total outlays, the benefits in efficiency, fraud reduction, and transparency are significant for health systems facing budget constraints. Cote d’Ivoire’s experience provides evidence for policymakers to consider institutionalizing digital payments to strengthen financial sustainability and support universal health coverage.

VL  - 11
IS  - 6
ER  - 

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